Migraine Medications for Kids

There are safe and effective treatment options that can improve your child's migraines. Symptoms of childhood migraines include headaches, vomiting, stomach aches, irritability, and fatigue. Parents and children might not always recognize the effects of a migraine, but treating these episodes at an early stage can help alleviate hours, or even days, of pain and discomfort.

After you and your child discuss the symptoms with your child's pediatrician, you can agree about what to do when a migraine occurs. If the migraines are frequent, you may need to discuss a preventative strategy as well.

There are a number of over-the-counter (OTC) and prescription medications used for migraine treatment and prevention. Most kids improve with OTC treatment, but sometimes, a prescription is necessary to manage the symptoms.

Over-the-Counter

If your child complains of occasional head pain, you may have tried OTC pain relievers already. These and anti-nausea medications are commonly used for childhood migraines. But it's important to discuss their use with your child's doctor and to use medication that is approved for your child's age, rather than using a lower dose of your own medication.

Children's doses are based on weight and the instructions for calculating the right dose are included on the box, often with measuring cups for liquid formulations.

Pain relievers: Tylenol (acetaminophen) and Advil (ibuprofen) are pain relievers that come in formulations for infants and young children. Aleve (naproxen), another commonly used pain reliever, is approved for children over the age of 12.

When taken as directed, these pain medications can be effective for relieving migraines in children.

Anti-nausea: For children, migraines can manifest with stomach discomfort, abdominal pain, aversion to food, nausea, or vomiting. Children's Benadryl (diphenhydramine) or Dramamine (dimenhydrinate) may relieve these symptoms, as well as headaches and pain.

Anti-nausea medications can be used during a migraine attack or as short-term prophylaxis if your child often gets migraines after certain triggers, such as traveling on an airplane.

Prescription

If your child's migraines do not improve with over-the-counter pain medications, it may be time to consider prescription options. Some prescription medications are used for the treatment of migraine episodes, while a few can be used on a daily basis for migraine prevention.

If your child is taking OTC or prescription migraine medications more than 8 days a month on average, this is a high frequency of migraines. This could be due to medication overuse or to other factors. It would be worthwhile to discuss the idea of a daily preventative medication instead of frequent use of medication for migraine attacks with your child's doctor.

If your child has four or more migraines a month that cause disability, such as missing school or other activities, this could be another reason to consider preventative management.

Prescription options include:

• Anti-nausea medications: Prescription-strength antiemetics like Zofran (ondansetron) can relieve nausea and vomiting, as well as other migraine symptoms, such as headaches and neck pain. For children, they are usually used during an acute migraine, but they can be used as migraine prophylaxis as well.
• Periactin (cyproheptadine): An antihistamine, cyproheptadine has long been used for childhood migraines. It has been recommended as a preventative medication, and it can be used for the treatment of an acute attack as well. Because cyproheptadine can cause sedation and increase appetite (causing weight gain), some people prefer not to use it every day and take it only for the treatment of acute migraine attacks.
• Triptans: Triptans are potent prescription medications used for the treatment of moderate to severe migraine episodes. A few triptans, including Zomig (zolmitriptan) nasal spray, Axert (almotriptan), and Maxalt (rizatriptan), are approved for children. Your child's doctor will give you specific instructions regarding how much your child should take, when and how often the dose can be repeated, and when to call about side effects.

Taking the medication right at the start of the symptoms is the best way to prevent a migraine attack from worsening. Your child may need to talk to the teacher and go to the school nurse if symptoms begin during school.

It is worthwhile for you to talk with your child about the various symptoms that occur with his or her migraines and to try to identify the earliest signs. Some children experience a prodromal stage before a migraine reaches its peak. Symptoms during the prodromal stage can include dizziness, stomach aches, photophobia (sensitivity to light), phonophobia (sensitivity to sound), osmophobia (sensitivity to smell), irritability, and sleepiness.

Over time, your child can learn to recognize these and seek treatment as early as possible.

Of course, medications can only do so much. Avoiding migraine triggers is an essential part of a complete migraine treatment and prevention plan.

Migraines can be triggered by a number of factors, including stress and lack of sleep. As a parent, you can work with your child to figure out if any of these factors cause your child's migraines—and how to avoid them.

Paying attention to these migraine triggers can often alleviate the need for medication in the first place:

• Lack of sleep
• Skipping meals
• Stress and anxiety
• Excessive computer and electronic use
• Caffeine intake
• Dietary triggers

Unless you find a specific dietary migraine trigger, putting your child on a restrictive diet is not a good idea. Kids can be pretty picky about food, and unnecessarily eliminating foods "just in case" won't prevent migraines.

Be sure to discuss your child's symptoms with his or her doctor before concluding that they are migraines. Some children have allergies, anxiety, or even medical problems that can manifest in the same way as migraines. Once migraines are diagnosed, you can focus on managing and preventing the episodes.

Talk to your pediatrician if your child's migraines worsen, change, or if your child develops new symptoms.